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SAN .IOAOIIIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIV ' <br />304 E WEBER AVE - 3RD FLOOR "• <br />S'TOCKTON. CA 95202 <br />209A6&3420 <br />INVOICE <br />DICK GUTHRIE <br />.I & D AUTO BODY IN(' <br />400A N CLUFF AVE <br />LODI CA 95240 <br />Health <br />Date Program Description <br />Invoice If IN0082786 — Date of Invoice . 4110101 <br />411012001 2220 SM HW GEN<5 TONSIYR <br />411012001 2399 UNIFIED PROGRAM FAC STATE SERVICE FEE <br />Please make Checks PAYABLE to: PIIS/EIID / <br />at the Rate of l00% of the Base Fee <br />30 Days after the Due Date <br />5255.rpf <br />Account ID AR0021499 <br />FA0012811 <br />Facility ID <br />Date Printed F4/10101 <br />RE: J & D AUTO BODY INC <br />400 N CLUFF AVE # A <br />LODI CA 95240 <br />OWNER: GUTHRIE, DICK A <br />Hm Employee Amount <br />$100.00 <br />$10.00 <br />Total for this Invoice $110.00 <br />Payment Due Date 511012001 <br />TOTAL DUE this Billing Periodl $110.00 <br />Return a Copy of This STATEMENT with Your PAYMENT <br />For all SERVICE FEES <br />Penaltles wlll be added at the Rate of 10% <br />60 Days after the Invoice Date and each 30 thereafter <br />